Evidence suggests that self-focused attention and cognitive failures may have disruptive effects on the use of specific coping strategies in stressful situations. In this study the personality factors of private self-consciousness (dispositional self-attention) and cognitive failures were investigated in relation to coping processes in specific stressful episodes reported by 139 female nurses. Multiple regression analyses were run to test for personality predictors of problem-focused coping, emotion-focused coping, and suppression-coping strategies. In examining the relationship between personality factors and coping the possible (...) mediational role of subjects' appraisals (importance of the episode and perceptions of control) were investigated. The results showed significant negative correlations between self-attention and emotion-focused and problem-focused coping only in mixed controllability situations. A significant negative correlation between cognitive failures and suppression was similarly dependent on subjects' situation specific control appraisals. The specificity of these relationships is interpreted in terms of the different effects which self-focus, cognitive failures, and control appraisals have on attention. (shrink)

Experimental, theoretical, psychological, and economic barriers have caused physicians to rely on biomedical treatments for infertility at the exclusion of more environmentally oriented ones (e.g., psychosocial stress therapy). An evolutionary model is described for the origin of reproductive failure, suggesting why mammals evolved to be reproductively responsive to the environment and why psychosocial stress should have an especially strong impact on fertility problems. A study of the causal role of psychosocial stress in infertility is then summarized. (...) The paper concludes with implications for future directions for the treatment of infertility and related human reproductive problems. (shrink)

I argue that gendered stereotypes, gendered emotions and attitudes, and display rules can influence extrinsic regulation stages, making failure points likely to occur in gendered-context and for reasons that the emotion regulation literature has not given adequate attention to. As a result, I argue for ‘feminist emotional intelligence’ as a way to help escape these failures. Feminist emotional intelligence, on my view, is a nonideal ability-based approach that equips a person to effectively reason about emotions through an intersectional lens (...) and use emotions to inform how we think and react to the world. This includes being attuned to the ways in which the world and our emotional lives are structured by and favors men. It stresses the need to be attuned to, as well as resist and challenge gender-based stereotypes and attitudes around emotions, paying close attention to the ways those stereotypes, norms, and attitudes differ across race, class, ethnicity, et cetera. (shrink)

The purpose of the present study was to test the hypothesis that goal orientation is associated with divergent forms of emotional reactivity under frustration. Goal orientations were assessed using bifurcations of performance goals described earlier. Physiological stress levels were measured via a blood volume pulse analysis after individuals were subjected to a computerized Stroop task using a malfunctioning mouse to induce enhanced frustration. The results indicated that performance-avoidance goals were associated with the highest levels of emotional reactivity, with normative (...) outcome goals being significantly more detrimental than ability goals. We concluded that the motivation to avoid failure or to outperform others is the most detrimental determinant of stress and needs to be avoided by all means. Instead, it is suggested that educators emphasize performance using personal best outcomes or by valuing engagement, deep processing and task completion. (shrink)

Twentieth-century action theory has concentrated on the relationship of intention to action, and thereby the relationship of belief as an occurrent state of the agent to the agent’s action. This stress on belief appears to be predicated on the view that our actions are primarily guided by our understanding of the relevant conditions of action, a view encouraged by the fact that we can and do attribute beliefs to ourselves and others to explain instances of the failure of (...) an action toachieve a desired outcome. I argue that, to the contrary, there is no compelling reason to conclude that such attributions imply that our actions are guided by occurrent beliefs. The alternative view offered is that our actions are typically guided by habit, but in cases of pragmatic failure we attribute putative prefailurebeliefs on the basis of the overall intention of action and relevant background understanding. (shrink)

Underperformance under stress is common in many activities such as the arts and academic performance, but examples are particularly evident in sport's "choking" effect—a failure to perform to levels already achieved when the person tries to be at his or her best. Rory McIlroy "disintegrated" at the 2011 U.S. Masters, while Greg Norman epically lost in 1996. On the other end of the spectrum, Mark Spitz and Michael Phelps thrived under media pressure to deliver record-breaking performances at the (...) Olympics. The first set of scenarios showcases athletes failing under pressure. The second presents superb performers who excel when "on the spot." As a way to supplement current psychological and cognitive theoretical research, Dr. Jesús Ilundáin-Agurruza discusses an alternative philosophical account to combat choking. It diagnoses the process and contrasts it with cases of superior performances analyzed under "skillful fluency." The solution is derived from Japanese do—arts of self-cultivation, such as the way of archery or the way of tea—which encourage an integration of body-mind and intellect-emotion that indirectly achieves skillful fluency and avoids choking. (shrink)

The purposes of this article were to obtain mechanical properties of the dry femur cortical bone samples through a tensile load and stress concentration factor approach and to provide simulations to predict experimental behaviors based on manipulations of certain properties and parameters of the biomaterial. Since bone samples have characteristics and geometries, the development of a mathematical model was necessary to describe the combination of stresses interacting in the bone when a tension load is applied. The samples have average (...) diameters and lengths of 0.5 and 2 inches respectively and were tested using a 10 kN Universal Tensile Machine to determine mechanical properties such as yield and ultimate stress, young module, and fracture, among others. Several simulations were conducted to evaluate failure criteria like “Von Mises”, “Tresca” and “Tsai-Wu”. Finally, was concluded that 83% of the data obtained from the 22 samples observed in the “Stress-Strain” charts showed a directly proportional relationship. (shrink)

During the nineteenth century, neuroanatomical knowledge and the clinical practice of treating mental illnesses develop at the same time. Some practitioners of mental medicine try to combine the clinical practice of treating mental diseases with neuroanatomical knowledge using the idea of cerebral localisations. This point of view is advocated by Gall and the field of phrenology. But there is no obvious success of such a localisationist project before Broca and Wernicke’s works on aphasia. This discovery will provoke a revival of (...) the desire to localise the cerebral zones involved in mental diseases. However, the cerebral localisation project progressively decreases during the end of the nineteenth century while neurological clinical practice emerges. Moreover, neurological clinical practice aims to localise anatomical lesions through clinical examination. From a philosophy of science point of view, this segment of history brings into question the relation between a scientific object (the cerebral localisation of zones involved in diseases) and a scientific subject (psychiatry and neurology). It stresses how a scientific project can migrate from one subject to another. (shrink)

This book highlights the unique need for philosophy among engineers, which stems from issues regarding their knowledge, role or being and influence. It discusses practice, context, ethics, models and failure as key aspects of engineering, and provides an easy but essential introduction to philosophy for engineers by presenting four key philosophers and linking them to these aspects: Karl Popper, Thomas Kuhn, Michael Polanyi and Martin Heidegger. Popper, Kuhn and Polanyi are philosophers of science who have challenged the view that (...) science is a ‘cool, detached’ discipline, since it also depends on human imagination, consensus and judgment plus artistry ; factors that are central to engineering. Heidegger critiqued technology on the one hand, but also stressed the importance of ‘doing’ over ‘knowing,’ thus ‘authenticating’ the highly pragmatic engineering profession. Science is the ‘core’ component of engineering, which is overlaid by a variety of heuristics. Practice-based knowledge can be formalized, with artificial intelligence offering a valuable tool for engineering, just as mathematics has done for science. The book also examines systems thinking in engineering. Featuring numerous diagrams, tables and examples throughout, the book is easily accessible to engineers. (shrink)

ObjectiveEfforts to understand why some marriages thrive while others falter are not well integrated conceptually and rely heavily on data collected from White middle-class samples. The Vulnerability-Stress-Adaptation Model is used here to integrate prior efforts and is tested using data collected from couples living with low incomes.BackgroundThe VSA Model assumes that enduring vulnerabilities, stress, and couple communication account for unique variance in relationship satisfaction, that communication mediates the effects of vulnerabilities and stress on satisfaction, and that the (...) predictors of satisfaction generalize across socioeconomic levels. To date, these assumptions remain untested.Materials and methodsWith 388 couples from diverse backgrounds, we used latent variable structural equation models to examine enduring vulnerabilities, chronic stress, and observed communication as predictors of 4-wave, 27-month satisfaction trajectories, first as main effects and then interacting with a validated 10-item index of sociodemographic risk.Results The three variable sets independently predict satisfaction trajectories; couple communication does not mediate the effects of enduring vulnerabilities or stress on satisfaction; and in 19% of tests, effects were stronger among couples with higher sociodemographic risk.ConclusionEffects of established predictor domains on satisfaction replicate in a diverse sample of newlywed couples, and most findings generalize across levels of sociodemographic risk. The failure of couple communication to mediate effects of enduring personal vulnerabilities and stress raises new questions about how these two domains undermine committed partnerships. (shrink)

Eyewitnesses are often susceptible to recollection failures and memory distortions. These failures and distortions are influenced by several factors. The present review will discuss two such important factors, attention failures and stress. We argue that acute stress, often experienced by eyewitnesses and victims of crimes, directly influences attentional processes, which likely has downstream consequences for memory. Attentional failures may result in individuals missing something unusual or important in a complex visual field. Amongst eyewitnesses, this can lead to individuals (...) missing details, even unusual or important central details, regarding the crime. Surprisingly, few studies have investigated attentional failures in eyewitness scenarios, and none have investigated the relationship between stress, attention, and witness memory. This review will discuss the impact of attentional failures, mainly those resulting from inattentional blindness, in applied contexts in order to bridge to eyewitness scenarios. In addition, we will integrate the applied literature on attentional failures with literature that examines the influences of arousal and stress on attention. We will conclude by presenting how future research may tease apart the independent contributions of arousal and stress on attentional failures and successes and how this research may inform understanding of eyewitness reliability. (shrink)

Despite advances in the treatment of heart failure, the physical symptoms and stress of the disease continue to negatively impact patients’ health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve (...) the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care. (shrink)

Cultural realities: ethics, values and morals -- Moral stress, distress, and injury -- An ethnography of ethics -- Ethics, geography, and mapping: the failure of the simple -- The tobacco problem -- The morals in the map: stress and distress -- Moral communities and their members -- Mapping poverty: ethics and morals -- An educational example -- Mapping justice as transportation -- Ethics and transplantation -- The ethics of scale, the scale of distress -- It's ... complex.

Japan is ordinarily thought of as a country noted for its lack of violent crime and the general safety of its citizens. But there is now widespread incidence, almost an epidemic, of bullying (ijime), student violence against other students, and against teachers, juvenile delinquency, violence in the home, and a growing rate of absenteeism and youth suicide for reasons related to the larger problem. Another issue, which has heretofore not been connected to the anti-social behavior of Japanese youth, iskaroushi, usually (...) translated as sudden death from overwork, and it is my contention that they share the same roots: the failure to learn self-control, and the perception that the locus of control is external.It is the tentative thesis of this essay that, on the one hand, Japanese society in general places too much emphasis onexternal locus of control (rules, regulations, authority figures), and that, on the other hand, individual parents — through such things as over-indulgence — do not teach their children sufficientself-(internal) control. In this essay I present the concept of perceived locus of control as it relates to various aspects of personality and development, and therefore to the problems of anti-social behavior and the meaning of work. (shrink)

How is it possible, that after the exhilarating start of democratic transitions in the late 1980s and 1990s, today authoritarian–populist options seem to be emerging in many new, as well as old democracies? Why does populism, that in most of its historical varieties has been anti-institutional and anti-procedural, turn to constitution making and constitutional rhetorics as one of its main arenas of contestation? The answers to these questions are related. In the following, in the form of six theses, I start (...) with what I mean by ‘populism’. Next, I wish to point to the two deficits of liberal democracy that provides the context for the rise of populist politics. These deficits according to me have been intensified in many of the new democracies. I continue by stressing populisms own deficits as the reason for turning to the constituent power. I end with a consideration of what liberal democrats can do to address the causes of the populist temptation. (shrink)

Patterns of reproductive failure described in humans and other mammals suggest that reproductive failure may in many instances be the result of adaptations evolved to suppress reproduction under temporarily harsh conditions. By suppressing reproduction under such conditions, females are able to conserve their time and energy for reproductive opportunities in which reproduction is most likely to succeed. Such adaptations have been particularly important for female mammals, given (a) the amount of time and energy that reproduction requires, and (b) (...) the degree to which reproductive conditions can vary.The existence of conscious and unconscious mechanisms to suppress reproduction under poor conditions has several implications for obstetric/gynecologic practices. Two implications are discussed with reference to biotechnological advancements in our ability to facilitate conceptions and manage problem pregnancies: (a) potential dangers of sophisticated technologies overriding natural fertility controls; and (b) the need for greater appreciation of the association between psychosocial stress and reproductive failure in the treatment of reproductive problems. Implications for elective abortion practices are discussed as well. (shrink)

Job performance and job stress are widely studied phenomena in occupational research. However, most of the literature on the relationship between work stress and job performance conceptualizes job stress as an antecedent of performance, in line with the stress-performance framework, and does not examine what happens to the well-being of the employees after the performance was appraised as poor. In the current theoretical paper, I argue that task underperformance is a source of stress (i.e., stressor) (...) for the employee, and as such can affect a wide range of employee outcomes. Task underperformance is conceptualized as comprised of two main types: acute/episodic underperformance such as a mistake or an accident (e.g., medical error, service failure), and chronic task underperformance such as not achieving the expected work products over time, with an interplay between these types. The source of the appraisal (objective, supervisor-rated, and self-rated underperformance) is also considered. Several disjoint literatures are then integrated in order to explain how underperformance is expected to result in subsequent decrements to employee well-being. At the chronic underperformance level, the following literatures are included: self-efficacy, negative effects of performance feedback, stress experienced when the basic need for competency is frustrated or when underperformance presents a threat to the self-image. At the acute/episodic level, affective and cognitive outcomes are explored and examples are drawn from several industries including service failures and medical errors. The interplay between the two types of underperformance, acute/episodic and chronic, is discussed, and then relevant moderators are offered. One notable moderator is the occupation-level consequences of error which likely affects most if not all outcomes. Finally, the discussion includes potential theoretical and practical implications for this conceptualization, as well as some methodological considerations for future research in this area. (shrink)

The executive hypothesis of self-regulation places cognitive information processing at the center of self-regulatory success/failure. While the hypothesis is well supported by cross-sectional studies, no study has tested its primary prediction, that temporary lapses in executive control underlie moments of self-regulatory failure. Here, we conducted a naturalistic experiment investigating whether short-term variation in executive control is associated with momentary self-regulatory outcomes, indicated by negative affect reactivity to everyday stressors. We assessed working memory capacity (WMC) through ultra-brief, ambulatory assessments (...) on smart phones five times per day in a 7-day ecological momentary assessment (EMA) study involving college-aged adults. We found that participants exhibited more negative affect reactivity to stressor exposures during moments when they exhibited lower than usual WMC. Contrary to previous findings, we found no between-person association between WMC and average stress reactivity. We interpret these findings as reflecting the role of executive control in determining one’s effective capacity to self-regulate. (shrink)

The input data to grammar learning algorithms often consist of overt forms that do not contain full structural descriptions. This lack of information may contribute to the failure of learning. Past work on Optimality Theory introduced Robust Interpretive Parsing (RIP) as a partial solution to this problem. We generalize RIP and suggest replacing the winner candidate with a weighted mean violation of the potential winner candidates. A Boltzmann distribution is introduced on the winner set, and the distribution’s parameter $T$ (...) is gradually decreased. Finally, we show that GRIP, the Generalized Robust Interpretive Parsing Algorithm significantly improves the learning success rate in a model with standard constraints for metrical stress assignment. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Sovereignty of Reason: The Defense of Rationality in the Early English Enlightenment by Frederick C. BeiserJohn W. YoltonFrederick C. Beiser. The Sovereignty of Reason: The Defense of Rationality in the Early English Enlightenment. Princeton: Princeton University Press, 1996. Pp. xi + 332. Cloth, $39.50.Beiser characterizes the methodology of his study as historical and philosophical: historical in placing texts in their own context and in uncovering the intentions (...) of their authors; philosophical in reconstructing and appraising arguments (ix). Both methods are necessary for good historical work. The second is often practiced without the first, to the detriment of philosophy and its history. “A philosopher who reconstructs arguments without the aid of history indulges in mere guesswork and anachronism, measuring the standards of philosophical relevance and importance by the concerns of his own age” (x). Equally, understanding the arguments and ideas of, e.g., seventeenth-century writers, “also involves testing their truth: seeing how they cohere with one another, what their consequences are, whether they follow from the evidence adduced for them, and if they reply to the objections made against them” (x). This splendid study of the role of reason in seventeenth-century religion, science, and philosophy is a fine example of careful textual-historical scholarship with rigorous philosophical analysis.The goal of his study is to tell “the story of how rationalism, in the very specific sense of the sovereignty of reason, arose in seventeenth-century England” (5). Starting with an introduction which discusses such topics as “The Paradox of the English Enlightenment,” “Rationalism in the English Church,” “The Enlightenment and the New Sciences,” Beiser proceeds to detailed presentations and discussions of “The Protestant Challenge” (Chap. 1); Richard Hookers’s defense of reason (Chap. 2); the views of the Great Tew Circle, e.g., Falkland, Chillingworth, Hammond, Hales (Chap. 3); the Cambridge Platonists (Chap. 4); the nature of Enthusiasm (Chap. 5); John Toland and Deism (Chap. 6); and ethical rationalism (Chap. 7).Many of the topics covered have been the subjects of other books and articles. What marks Beiser’s account is the freshness of his approach, the many new insights and suggestions about the tensions between the holders of traditional doctrines and newer challenges. Beiser’s writing is clear, and the issues are carefully presented and analyzed. One of the central themes is the mistake of equating “rationalism with the critique or rejection of religion” (15), of identifying enlightenment with secularization (14). The appeals to reason often emerge from within orthodox religion, whose defenders were trying to cope with their own internal tensions. “Once we consider the Cambridge Platonists’ early reaction to predestination, it becomes clear that it was not Hobbes but Calvin who first posed the danger of atheism for them. For it was Calvin’s theology, and not Hobbes’s materialism, that inspired the fear of God that [End Page 138] they regarded as the source of atheism. In the eyes of the Cambridge Platonists, Hobbes’s materialism was only a false remedy for that fear...” (147). A similar point is made later: “the foundations of a rational theology” in Whichcote “did not arise from any need to combat a creeping Hobbesianism. Rather, it grew up from the inner struggles and torments of the Protestant soul” (165).Equally significant is Beiser’s analysis of enthusiasm, the appeals to divine inspiration rather than to reason or evidence: “We should be aware of accepting the contemporary caricature of the enthusiasts, which portrayed them as zealous and ignorant anti–intellectuals with no cogent or coherent philosophical position of their own” (187). His analysis of the enthusiasts stresses the epistemological nature of their position, rather than the usual theological, ethical, or political dimensions (193). He insists that “enthusiasm is essentially a philosophical concept. Historically, it arose as a response to the problem of the sources and criteria of religious knowledge” (187). The search for criteria is a pervasive feature of Beiser’s study: Luther’s and Calvin’s efforts to draw the boundary between faith and reason (24); Richard Hooker’s failure to “provide an epistemological foundation for his theory of natural law” (67); the need for a criterion to distinguish genuine from false revelation... (shrink)

Various captivity-related health problems have been described as arising in the farming of sea turtles at the Cayman Turtle Farm (CTF). Our study included a desktop review of turtle farming, direct onsite inspection at the CTF, assessment of visual materials and reports provided by investigators from the World Society for the Protection of Animals (WSPA), and a limited analysis of water quality for potential pathogens. In particular, we assessed physical and behavioural condition of animals for signs of stress, injury (...) and disease. During the onsite inspection we identified three distinct signs of physical injury and disease, six distinct signs of abnormal and problematic arousal- and discomfort-related behaviour; and three distinct signs of normal quiescence- and comfort-related behaviour. On evaluation of evidence provided by the WSPA we identified ten distinct signs of physical injury and disease, and management- or genetic-related conditions; six distinct signs of abnormal and problematic arousal- and discomfort-related behaviour; and three distinct signs of normal quiescence- and comfort-related behaviour. We conclude that sea turtles at the CTF manifested important physical and behavioural signs that are indicative of problematic management and captivity-related stress, and the limitations of sea turtle adaptive plasticity in captivity. The problematic physical and behavioural signs, in our view, related to the inherent nature of intensive turtle propagation which in particular involves overt- and crypto-overcrowding and understimulating environments, and an associated failure to meet all the physical, biological and innate behavioural needs of sea turtles. (shrink)

This article takes the failure to grasp fully the paradigmatic case of European security after the Cold War as an example of how International Relations (IR) would benefit from reformulating not only its empirical research questions but also several of its central conceptual building blocks with the aid of Bourdieusian sociology. The separation between theory and practice and the overemphasis on military power and state actors blind IR from seeing the power struggles that reshaped European security. Instead, a Bourdieusian (...) reformulation adds new types of agency, focuses on the social production of forms of power, and stresses the processual rather than the substantive character of social reality. (shrink)

Recently in Porter v. McCollum, the United States Supreme Court, citing “a long tradition of according leniency to veterans in recognition of their service,” held that a defense lawyer’s failure to present his client’s military service record as mitigating evidence during his sentencing for two murders amounted to ineffective assistance of counsel. The purpose of this Article is to assess, from the just deserts perspective, the grounds to believe that veterans who commit crimes are to be blamed less by (...) the State than offenders without such backgrounds. Two rationales for a differential treatment of military veterans who commit crimes are typically set forth. The Porter Court raised each, stating that we should treat veterans differently “in recognition of” both “their service” and “the intense stress and mental and emotional toll” of combat. The former factor suggests there being a “social contributions” or gratitude-based discount, whereas the latter factor points towards a “mental disturbance” discount. This Article analyzes the two accounts and raises some doubts about both. This Article then argues that a military veteran who commits a crime should not be blamed to the full extent of his blameworthiness, not necessarily because of his mental capacity nor because of his social contribution, but because the State’s hand in producing his criminality undermines its standing to blame him. (shrink)

This chapter argues that a virtue-theoretic account of argumentation can enhance our understanding of the phenomenon of populism and offer some lines of response. Virtue theories of argumentation emphasize the role of arguers in the conduct and evaluation of arguments and lay particular stress on arguers’ acquired dispositions of character, otherwise known as intellectual virtues and vices. One variety of argumentation of particular relevance to democratic decision-making is group deliberation. There are both theoretical and empirical reasons for maintaining that (...) intellectual humility is pivotal to the practice of group deliberation. Several factors to which the rise of populism has been attributed may be understood as failures of the virtues of argumentation in general, and intellectual humility in particular. (shrink)

n his 1785 review of Herder’s Ideen zur Geschichte der Menschheit Kant stresses the negative effects of sensibility and imagination in undermining philosophy. This essay will offer a defence of Herder against Kant in order to gesture towards a more positive account of the cognitive function of these capacities. I will argue that the eighteenth-century fascination with the experimental sciences and the demand to engage in anti-speculative philosophy in fact called for the integration of sensibility and imagination. The reason for (...) this call is that it is in virtue of these capacities that the mind is able to focus on the world of particulars and avoid the kind of metaphysical speculation that came under attack for its failure to account for the experienceable reality of human life. By analysing which cognitive role Herder attributes to our sensible and imaginative engagement with the world, it will emerge that the kind of inquiry advocated as a remedy against school metaphysics was not a reductive form of verificationism that pits the benefits of observation against reason, but a position marked by the belief that the mind’s best results can be achieved only if it commits itself to an integrated use of its rational and non-rational capacities. (shrink)

The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as a destination (...) therapy raises certain ethical challenges. Left ventricular assist devices can prolong the survival of average recipients compared with optimal medical management of chronic end-stage heart failure. However, the overall quality of life can be adversely affected in some recipients because of serious infections, neurologic complications, and device malfunction. Left ventricular assist devices alter end-of-life trajectories. The caregivers of recipients may experience significant burden (e.g., poor physical health, depression, anxiety, and posttraumatic stress disorder) from destination therapy with left ventricular assist devices. There are also social and financial ramifications for recipients and their families. We advocate early utilization of a palliative care approach and outline prerequisite conditions so that consenting for the use of a left ventricular assist device as a destination therapy is a well informed process. These conditions include: (1) direct participation of a multidisciplinary care team, including palliative care specialists, (2) a concise plan of care for anticipated device-related complications, (3) careful surveillance and counseling for caregiver burden, (4) advance-care planning for anticipated end-of-life trajectories and timing of device deactivation, and (5) a plan to address the long-term financial burden on patients, families, and caregivers. Short-term mechanical circulatory devices (e.g. percutaneous cardiopulmonary bypass, percutaneous ventricular assist devices, etc.) can be initiated in emergency situations as a bridge to permanent implantation of ventricular assist devices in chronic end-stage heart failure. In the absence of first-person (patient) consent, presumed consent or surrogate consent should be used cautiously for the initiation of short-term mechanical circulatory devices in emergency situations as a bridge to permanent implantation of left ventricular assist devices. Future clinical studies of destination therapy with left ventricular assist devices should include measures of recipients' quality of end-of-life care and caregivers' burden. (shrink)

Evaluative contexts can be stressful, but relatively little is known about how different individuals who vary in responses to self-evaluation make emotion regulatory choices to cope in these situations. To address this gap, participants who vary in self-esteem gave an impromptu speech, rated how they perceived they had performed on multiple evaluative dimensions, and subsequently chose between disengaging attention from emotional processing and engaging with emotional processing via changing its meaning, while waiting to receive feedback regarding these evaluative dimensions. According (...) to our framework, distraction can offer stronger short-term relief than reappraisal, but, distraction is costly in the long run relative to reappraisal because it does not allow learning from evaluative feedback. We predicted and found that participants with lower self-esteem react defensively to threat of failure by seeking short-term relief via distraction over the long-term benefit of reappraisal, as perceived failure increases. Implications for the understanding of emotion regulation and self-esteem are discussed. (shrink)

This paper defends an ‘opt-out’ scheme for organ procurement, by distinguishing this system from ‘presumed consent’ (which the author regards as an erroneous justification of it). It, first, stresses the moral importance of increasing the supply of organs and argues that making donation easier need not conflict with altruism. It then goes on to explore one way that donation can be increased, namely by adopting an opt-out system, in which cadaveric organs are used unless the deceased (or their family) registered (...) an objection. Such policies are often labelled ‘presumed consent’, but it is argued that critics are right to be sceptical of this idea—consent is shown to be an action, rather than a mental attitude, and thus not something that can be presumed. Either someone has consented or they have not, whatever their attitude to the use of their organs. Thankfully, an opt-out scheme need not rest on the presumption of consent. Actual consent can be given implicitly, by one's actions, so it is argued that the failure to register an objection (given certain background conditions) should itself be taken as sign of consent. Therefore, it is permissible to use the organs of someone who did not opt out, because they have—by their silence—actually consented. (shrink)

Whether we're buying a pair of jeans, ordering a cup of coffee, selecting a long-distance carrier, applying to college, choosing a doctor, or setting up a 401(k), everyday decisions ; both big and small ; have become increasingly complex due to the overwhelming abundance of choice with which we are presented. As Americans, we assume that more choice means better options and greater satisfaction. But beware of excessive choice: choice overload can make you question the decisions you make before you (...) even make them, it can set you up for unrealistically high expectations, and it can make you blame yourself for any and all failures. In the long run, this can lead to decision-making paralysis, anxiety, and perpetual stress. And, in a culture that tells us that there is no excuse for falling short of perfection when your options are limitless, too much choice can lead to clinical depression. In The Paradox of Choice, Barry Schwartz explains at what point choice ; the hallmark of individual freedom and self-determination that we so cherish ; becomes detrimental to our psychological and emotional well-being. In accessible, engaging, and anecdotal prose, Schwartz shows how the dramatic explosion in choice ; from the mundane to the profound challenges of balancing career, family, and individual needs ; has paradoxically become a problem instead of a solution. Schwartz also shows how our obsession with choice encourages us to seek that which makes us feel worse. By synthesizing current research in the social sciences, Schwartz makes the counter intuitive case that eliminating choices can greatly reduce the stress, anxiety, and busyness of our lives. He offers eleven practical steps on how to limit choices to a manageable number, have the discipline to focus on those that are important and ignore the rest, and ultimately derive greater satisfaction from the choices you have to make."--provided by publisher. (shrink)

The Modularity of Mind proposes an alternative to the or view of cognitive architecture that has dominated several decades of cognitive science. Whereas interactionism stresses the continuity of perceptual and cognitive processes, modularity theory argues for their distinctness. It is argued, in particular, that the apparent plausibility of New Look theorizing derives from the failure to distinguish between the (correct) claim that perceptual processes are inferential and the (dubious) claim that they are unencapsidated, that is, that they are arbitrarily (...) sensitive to the organism's beliefs and desires. In fact, according to modularity theory, perceptual processes are computationally isolated from much of the background knowledge to which cognitive processes have access. The postulation of autonomous, domain-specific psychological mechanisms underlying perceptual integration connects modularity theory with the tradition of faculty psychology, in particular, with the work of Franz Joseph Call. Some of these historical affinities, and some of the relations between faculty psychology and Cartesianism, are discussed in the book. (shrink)

If the force on a particle fails to satisfy a Lipschitz condition at a point, it relaxes one of the conditions necessary for a locally unique solution to the particle’s equation of motion. I examine the most discussed example of this failure of determinism in classical mechanics—that of Norton’s dome—and the range of current objections against it. Finding there are many different conceptions of classical mechanics appropriate and useful for different purposes, I argue that no single conception is preferred. (...) Instead of arguing for or against determinism, I stress the wide variety of pragmatic considerations that, in a specific context, may lead one usefully and legitimately to adopt one conception over another in which determinism may or may not hold. (shrink)

This paper has three aims. First, I aim to stress the importance of the issue of the dispositional/categorical distinction in the light of the evident failure of the traditional formulation, which is in terms of conditional entailment. Second, I consider one radical new alternative on offer from Ullin Place: intentionality as the mark of the dispositional. I explain the appeal of physical intentionality, but show it ultimately to be unacceptable. Finally, I suggest what would be a better theory. (...) If we take disposition ascriptions to be functional characterizations of properties, then we can explain all that was appealing about the new alternative without the unacceptable consequences. (shrink)

Disrespect in health care often persists despite firm commitments to respectful service provision. This conceptual paper highlights how the ways in which respect and disrespect are characterised can have practical implications for how well disrespect can be tackled. We stress the need to focus explicitly on disrespect (not only respect) and propose that disrespect can usefully be understood as a failure to relate to people as equals. This characterisation is consonant with some accounts of respect but sometimes obscured (...) by a focus on respecting people’s autonomy and dignity. Emphasising equality is consistent with connections patients draw between being (dis)respected and (in)equality. It readily accommodates microaggressions as forms of disrespect, helping to understand how and why experiences of disrespect may be unintentional and to explain why even small instances of disrespect are wrong. Our view of disrespect with an emphasis on equality strengthens the demand that health systems take disrespect seriously as a problem of social injustice and tackle it at institutional, not just individual levels. It suggests several strategies for practical action. Emphasising relational equality is not an easy or short-term fix for disrespect, but it signals a direction of travel towards an important improvement ambition. (shrink)

The unifying idea of Gramsci's famous Prison Notebooks is the concept of hegemony. In his study of these fragmentary writings, now published in paperback for the first time, Dr Femia elucidates the precise character of this concept, explores its basic philosophical assumptions, and sets out its implications for Gramsci's explanation of social stability and his vision of the revolutionary process. A number of prevalent and often contradictory myths are demolished, and, moreover, certain neglected aspects of his thought are stressed, including (...) the predominant role he attributed to economic factors, the importance he gave to 'contradictory consciousness', and the close connection between his political thinking and his fundamental philosophical premises. The author concludes by critically examining Gramsci's novel solutions to three long-standing problems for Marxist theory: why has the Western working class not carried out its revolutionary mission; what is the appropriate strategy for a Marxist party working within an advanced capitalist framework; and what are the reasons behind the failure of existing socialist states in their task of liberation. (shrink)

The book reconstructs the history of Western ethics. The approach chosen focuses the endless dialectic of moral codes, or different kinds of ethos, moral doctrines that are preached in order to bring about a reform of existing ethos, and ethical theories that have taken shape in the context of controversies about the ethos and moral doctrines as means of justifying or reforming moral doctrines. Such dialectic is what is meant here by the phrase ‘moral traditions’, taken as a name for (...) threads of moral discourse, made in turn of other interwoven threads, including transmission of shared codes, appeals to reform of prevailing custom, rational argument about the justification of some precept on the basis of some shared general teaching or principle, and rational argument about the ultimate basis for principles and justification of authoritative teaching. That is, the approach adopted to the reading of ethical texts depends on a firm belief in the fact that philosophers hardly created any ethical doctrine out of nothing. The main point this book tries to highlight is how different philosophical theories emerged and followed each other as a result of attempts at accounting for what was going on in the world of moral traditions. Changes were propelled by controversies between different schools, and highly abstract arguments were the unintended effects of moves made by controversialists forced to transform (and occasionally to turn upside down) their own doctrines in order to face the challenge posed by other arguments. This is the reason why the book examines not only texts that already enjoy pride of place in the history of philosophy (Aristotle, Kant, Hegel), but also other texts usually treated in the histories of religions (the Bible, the Talmud, the Quran), and others considered to be much less philosophical (Plutarchus, Pufendorf). -/- 1. Plato and a response to ethical scepticism. Two different traditions of morality in VI-V century Greece are described. The birth of philosophical questioning of traditional morality and temporal and spatial variation of custom is described within the context of the v century crisis, the demise of traditional aristocratic and tyrannical rule and the birth of democracy. Two conflicting answers to the challenge are reconstructed, namely conventionalist or immoralist theories formulated by the Sophists and the eudemonist and intellectualist Socratic theory. Plato’s own reformulation of Socrates answer to the Sophists is reconstructed. His psychological views, his classification of the four cardinal virtues and his political theory are described as parts of a unitary system, culminating in an extremely realist moral ontology identifying the idea of the good with the essence of the (moral and extra-moral) world itself. -/- 2. Aristotle and the invention of practical philosophy. Aristotle’s invention of practical philosophy as a field separated from first philosophy is shown to be an implication of his break with Plato moral ultra-realism. Aristotle’s agenda in his moral works is arguably dependent on a polemical intention, namely dismantling Socratic intellectualism. The semi-inductive or virtuously circular method of practical philosophy is illustrated, starting with the received opinions of the better and wiser individuals and trying dialectically to sift what is left of mistake and inconsistence in such opinions, finally trying to correct mistakes and make the overall practical science more consistent. The chapter illustrates then the relationship of individual ethics, or ‘monastics’, with the art and the science of the pater familias, or ‘economics’, and the science of the ruler and citizen, or politics. The nature of virtues, or better, excellences of character, is discussed, highlighting the basic role of hexis, or ‘disposition’. Prudence, or better practical wisdom, is the focus of the chapter. Its relationship with bouleusis or deliberation is examined, and its autonomous status vis-à-vis theoretical knowledge is stressed. -/- 3. Diogenes and philosophy as a way of life. The chapter provides an overview of Hellenistic ethics, which almost amounts to Hellenistic schools of philosophy, in so far as ‘philosophy’ became in these centuries primarily the name for a way of life. The typical character of the Cynical movement is highlighted, that of a school of life, not a school aimed at providing any kind of intellectual training was to be provided. -/- 4. Epicurus and ethics as self-care. The peculiar character of the Epicurean school is described, a combination of a science of well-being aiming, more than at pleasure as in the popular view, at reduction of useless suffering, of unnecessary needs, and at a balanced selection of pleasures of the best and most durable kind. -/- 5. Epictetus and ethics as therapy of the passions. The various phases of Stoicism are described, and the shifting place given to ethics in the Stoic system of idea, culminating in the paradoxical view of ethics, its impossibility in principle notwithstanding, as the only truly significant and necessary part of philosophy. Cicero is treated, showing how his own synthesis of various Hellenistic trends is as a truly philosophical enterprise, deserving serious consideration after one or two centuries when he was confined to the role of literate. Epictetus is chosen as the best example of what the Stoic tradition could yield, an art of living based on sophisticated introspection, in turn aimed at making a kind of cognitive therapy possible, dismantling obnoxious passions at their root by systematically correcting false representations. -/- 6. Philo and the reconciliation of Torah and Platonism. A reconstruction of basic ideas from a few books of the Hebrew Bible is provided, starting with the Prophetic tradition and the focus on God’s mercy as the source of motivation and standard for human behaviour. Then a comparative analysis is undertaken of a parallel tradition, namely the three codifications of the Torā (Law or, better, Instruction), highlighting how a core of moral ideas may be recognized as a basis and preamble of codification of civil law, cultural practice, and regulation of ritual purity. The importance of Leviticus is stressed as the turning point when emphasis mercy, typical of the Prophetic tradition, is combined with the legal tradition, yielding the change in sensibility of the Second Temple time. Philo of Alexandria is described as one of the three leading figures – together with Rabbi Hillel and Rabbi Yeshua – at the apex the emergence of the mentioned new sensibility, gradually including mercy as an essential part of justice and establishing the starting point of both the Rabbinic and the Christian tradition. This consists precisely in the precept of one’s neighbour’s love or of the golden rule, two eventually identical precepts whose meaning is arguably more sober and sensible than the long-lasting Christian tradition deriving from John and Augustine has made us believe and no novelty vis-à-vis so-called Ancient-Testament teachings. -/- 7. Augustine and Christianity as Neo-Platonism. The first section examines the moral doctrines of so-called 'ethical Treaties' from the Talmud, a group of treaties, among which the best known is Pirqé Avot, that were left out of the six "orders" of the canon as they did not fit in any of the six groups of issues ritual or legal on which the division was based. According to Maimonides, their peculiar theme is provided by the Deòt, 'opinions', i.e., mental dispositions, that is, the translation of the Greek term hexeis and Arab akhlak (in turn providing in this language the name for ethics as such). The three topics I reconstruct are: i) the notion of Torah: The Torah is understood as the world order itself, or as the ‘Wisdom’ that existed even before creation and was ‘the tool by which the world was built’; however, the Torah is an earthly and human entity, as it was "received" by humans, and from that very moment belongs to them; ii) the relationship between love of God and love of neighbour; the treaties require us to study and practice the Torah ‘for its own sake’, that is, require us to act out of love, not out of fear or hope of reward; iii) the idea of sanctification of daily life: having disappeared with the destruction of the Temple the possibility of any conflict between liturgical service and everyday life, the latter is assumed to be in itself divine service: to give food to the poor has the same value as sacrifices in the Temple, and as an implication, the insistence become recurrent on the goodness of created things in themselves along with a polemic against ascetic currents. The conclusions drawn are: i) the moral teachings of the Talmud and those of Yeshua are, rather than similar, virtually identical; one may safely say that the precept of love and the golden rule are central ones for all Talmudic rabbis, that mercy plays an indispensable role alongside with justice, and the latter is not a different thing from one’s neighbour’s love; ii) a peculiarity of Talmud rabbis facing Yeshua is the idea of study as worship, and knowledge as a source of justice; but this is an idea of Judaism after the Temple's destruction that cannot be attributed to the Pharisees of Yeshua’s time; iii) the relation of study and practice in the Talmud parallels that between faith and deeds in Paul's epistles, that is, respectively faith or learning are a necessary and sufficient condition to be recognized as righteous , but deeds are the inevitable effect of either faith or learning. The sayings ascribed to Yeshua are examined first, yielding the conclusion that a close equivalent may be found for every saying in Talmudic literature and yet the whole is ascribed to one rabbi, with rather consistent stress on God’s mercy and unconditional forgiving as the mark of true imitation of God. Thus, Yeshua’s teaching is pure Judaism. The third section describes briefly the galaxy of Gnostic currents and Manichaeism, trying to sketch the profile of moral teachings resulting from an encounter of Asian spiritual traditions, Hellenistic lore and sparks of teachings from apocalyptic Jewish currents. The last section summarizes the turbulent history of several encounters between Christian currents and Hellenistic philosophical schools. The first one was with late Cynicism. Recent, rather controversial, literature discovered the jargon and a few topics from the Stoic-Cynical popular philosophy in a few books from the New Testament itself. This, far from proving that Rabbi Yeshua had been influenced by cynic preachers, is a proof of the necessity felt by Christian preachers to translate the original ‘Christian’ teaching into a Greek lexicon deeply impregnated with cynic terminology. The second was with Platonism, yielding the mild and temperate moral teaching of Clemens of Alexandria, teaching the sanctity of nature and the human body, the joy of moderate fruition of ‘natural’ kinds of pleasures, and the beauty of the marital life – in short, the opposite of the standard picture of Medieval Christianity. Ambrose of Milan brings about a different kind of synthesis, namely with Middle Platonism, where Stoic themes prevail. The most shocking case is Augustine, where an early Manichean education is overcome in a former phase by a synthesis of Plotinian Neo-Platonism and Christian preaching, yielding a sustained polemic with the Manicheans and rather optimistic views on life and Creation, the body and sexuality, and Hebrew-Judaic tradition not far from Clemens of Alexandria. In a later phase, occasioned by controversy on the opposite front, with such Christian currents as the Pelagians and Donatists, Augustine comes back to heavily anti-Judaic and world-denying ascetic attitudes where is earlier Manichean upbringing seems to emerge again. The tragedy of medieval Christianity will be the later Augustine’s overwhelming influence. A final section is dedicated to the monastic tradition where a curious mixture of world-denying asceticism with an astonishingly penetrating ‘science’ of introspection emerges. -/- 8. Al Farabi and the reconciliation of Islam and Platonism. The Qurān and the qadit, that is, collections of sayings ascribed to the prophet Muhammad contain a wealth of precepts and catalogues of virtues mirroring moral contents from the Jewish and the Christian traditions, among them the basic notion of imitation of the Deity, where mercy is assumed to be its basic trait. An important tradition within Islam, namely Sufism, stressed to the utmost degree the role of mercy, turning Islam into a mystic doctrine centred on retreat from the world, abandonment to God’s will, and a peaceful and fraternal attitude to our fellow-beings. A secular literary tradition originating in the Sassanid Empire, the literature of advice to the Prince had for a time a widespread influence in the newly constituted Arabic-Islamic commonwealth. In a later phase, the legacy of Hellenic philosophy made its way into the intellectual elite of the Islamic world. The first important legacy was Platonic, and the Republic became the main text for Islamic Platonism. Al-Farabi wrote an enjoyable remake of the Platonic Republic, arguing that the citizen’s virtues were the basis on which the political building needs to rest. The secular lawgiver is enlightened by the light of reason in his everyday practice of governance, but room is made for the Prophet as the voice of revealed truth that confirms and completes the rational truth that philosophy may afford. In a second phase also Aristotelian and Stoic influence were assimilated. Miskawayh’s treatise was the masterwork at the time Arabic philosophy reached its Zenith. It is a treatment of the soul’s diseases and their remedies, combining the Aristotelian doctrine of the golden mean with the Stoic doctrine of the passions and elements of Galenic medicine. Towards the eleventh-twelve centuries a war raged among theologians and philosophers, finally won by the former with disappearance of philosophy as such. The newly established mainstream, yet, was no kind of intolerant fanaticism. It drew from the work of mystic theologian Al-Ghazālī, the best heir of Sufism, teaching a tolerant and peaceful attitude to our fellow-beings and a passive attitude to destiny as an expression of the Divine will. -/- 9. Moshe ben Maimon and the reconciliation of Torah and Aristotelian ethics. The encounter between the Talmudic tradition and Hellenic philosophy had taken place a first time in Alexandria at the time of Philo but the two traditions had parted way again. In fact, the kind of Platonic Judaism founded by Philo survived only within Christianity, in the fourth Gospel and then in writings by Clemens of Alexandria. The Talmudic literature had absorbed just less striking traits from the Hellenic Philosophy, namely an idea of ethics as care of the self and a role for the education of character as propaedeutic to theoretical knowledge. In the Arabic-Islamic world, a second round started when Jewish authors writing in Arabic undertook the task to prove the full compatibility of the tradition deriving from Torah and Platonic philosophy. The culmination of this attempt is provided by Moshe ben Maimon who tried to use Aristotelian ethics as a language into which the teaching from the Pirké Avot could be translated. -/- 10. Thomas Aquinas and the reconciliation of Christian morality and Aristotelian ethics. In the first section the fresh start is described of philosophical ethics in Latin Europe at the turn of the Millennium. In a first phase, Anselm and Peter Abelard built on a Platonic and Augustinian legacy. In this phase. remarkable innovations are introduced, including Abelard’s claim of the obliging character of erring consciousness. In a second phase, the rediscovery of Nicomachean Ethics thanks to Latin translation of Arabic versions gives birth to a new wave of ethical studies, recovering the very idea of Aristotelian practical philosophy, with the potential implication of full legitimization of natural morality, i.e. ethics without Revelation. Aquinas’s ethics is a theological ethics out of which it would be vain to try to extract a self-contained philosophical ethics. His treatment of topics in philosophical ethics, yet, does not boil down to repetition of Aristotelian arguments but is rather a creative reshaping of such arguments. For example, he introduces also in the practical philosophy a first principle parallel to the principle of non-contradiction; and he also carries out a synthesis of Aristotelianism, Stoicism, and neo-Platonism. Even though it is essentially moral theology, Aquinas’s doctrine - unlike Augustine – grants full citizenship to "natural" morality, firstly by rejecting the claim that the corruption of human nature due to the original sin is so radical as to leave "pure nature" incapable of moral goodness. The doctrine is presented in a more sophisticated formulation in a few of the Quaestiones, such as De Malo and De Veritate, in the Summa contra Gentes and in the commentaries to Aristotle than in the famous Summa Theologica, but the latter work includes the only or the largest exposition of some decisive part of the theory. Thus, the Summa Theologica should be read for what it is more than criticized for not being what it was not meant to be. It was not meant to be the brilliant synthesis of all that Reason he had been able to produce with what Revelation had added about which the Neo-Thomists used to dream, but rather a manual for the training of preachers and confessors, where theoretical claims are not too demanding and a few serious tensions are left. Besides a jump between the Prima Secundae and the Secunda Secundae, being the former an essay in virtue theory and the latter a handbook for confessors, the most serious tension is perhaps the one between the ethics of right reason presented in most of Ia-IIae and the eudemonistic ethics developed in quaestiones 1-5 of the same part; the alternative ethical theory which also may be found in Augustine, the Stoic view of a cosmic reason eventually coincident with the moral law, was believed by Anselm (followed by John Duns Scotus and William of Ockham) to be incompatible with eudemonism. It is questionable whether Thomas could reduce the tension proving that it is just an apparent tension, in so far as the right reason and bliss derived from knowledge of God tend to coincide, but this is just a conjecture. Thomas’s ethics is a virtue ethic, not a law-based one, and moral judgment focuses on the virtues, particularly charity, not on the commandments and even less on absolute prohibitions; Thomas, however, would not have considered a drastic alternative between law and the virtues such as the one which has been advanced in late twentieth-century philosophy to be justified. Nonetheless, when it discusses ‘special’ virtues, it ceases to be an ethics of virtue and becomes a disappointing and often contradictory discussion of legal and illegal acts. Such a discussion takes most of the time ‘reasonable’ middle positions on controversial issues but not the alternative approach that Aristotelianism would have made possible; even when some occasional Aristotelian claim shows up, such as money’s barrenness as a reason against usury, this seems to be made by an author who apparently ignores the Aristotelian Thomas of the Prima Secundae. It is an ethic of human autonomy which recognizes the binding character of the individual conscience and, potentially, even a duty to disobey unjust laws. It is true that what Thomas writes in his discussion of death penalty and persecution of heretics is simply disgusting, and yet we should blame Thomas the man, not Thomist ethical theory. Finally, Thomas’s ethics is not ethical ‘absolutism’, as both traditionalist Catholic theologians and secularist enemies of dogmatic morality tend to believe. It is instead an ethic of prudential judgment. Exceptions to this approach – or better results of logical fallacies – are such claims as the absolute character of negative precepts and of the existence of "intrinsically evil acts", claims that simply cease to make sense in the light of Thomas’s own distinction between human act and natural act, carrying consequences Thomas did not live long enough to draw or was not consistent enough to dare to draw. -/- 11. Francisco de Vitoria and casuistry. The first topic illustrated is the discussion about the notion of pura natura, namely the human condition after the original sin and before divine revelation. The core notion was already there in Aquinas but was later developed by Caietanus (Thomas de Vio) with a number of interesting implications: firstly a view of human nature as such much more positive than Augustine’s and his followers’ view, including both Calvinists and Jansenists; secondly, the implication that the philosopher’s morality, as opposed to the Christian’s morality, is a quite respectable kind of morality; thirdly, that theocracy and prosecution of the unfaithful lacked justification, with more far-fetching consequences than Aquinas himself had dared to draw. The second topic is casuistry, a new name for a comparatively older way of thinking, which was already there in late Stoicism and Cicero as well as in the Talmudic literature. This is an approach aimed at yielding probable enough solutions for doubtful cases even in absence of completely safe staring points. The genre developed from medieval reference books for confessors and became by the sixteenth-century a sophisticated tool-box for dealing with various fields of applied ethics. Francisco Vitoria, the main authority of Baroque Scholasticism, was a controversial figure, among the proponents of the new discipline of casuistry and a consistent proponent of more separation between the religious and the civil authority, stricter limits to the legitimacy of war, innate rights of non-Christian nations in the New World based on the notion of pura natura, providing a standard of ‘natural’ goodness, previous to revelation, on which the Indian nations were judged to live in a naturally good condition, provided with the institutions of family, justice, and religion had accordingly a right to full respect by Christian sovereigns. Bartolomé de Las Casas, arguing along similar lines, was the leader of a historical battle in defence of the rights of the Indios. -/- 12. Michel de Montaigne and the art of living. A short description of one of the Renaissance Phyrronism, one of the classical philosophies revived in the fifteenth and sixteenth century. Montaigne combines the sceptical epistemology with an understanding of ethics – indeed of philosophy as a whole – in terms of an art of living inspired by two basic ideas, sagesse, that is, practical wisdom as the only kind of rationality available after theology, science, and tradition have declared bankrupt, and an aesthetic ideal of self-transformation through the art of writing and introspection. -/- 13. Pierre Nicole and neo-Augustinianism. The chapter illustrates first the vicissitudes of Augustinianism newly born after the late medieval triumph of Thomist Aristotelianism in the alternative Protestant and Catholic versions processed by the Calvinists and the Jansenists. Then it illustrates the doctrines of Pierre Nicole, Blaise Pascal’s best disciple, on the impossibility of introspection, on the ubiquity of self-deception, on the incurably evil character of the passion of love, and on the two moralities, the one of the man of the world, the morality of honesty which is indispensable for granting peace and order but devoid of any true value for eternal salvation, since the same external behaviour may be prompted by opposite motivations, and the morality of charity, the only true one but also useless to society. The third topic is Pierre Malebranche’s view of self-deception as a ubiquitous phenomenon accounting for human action and responsibility and his reformulated theory of self-love, no less ubiquitous than for Nicole and yet not as incurably evil, given the distinction between morally indifferent and even necessary amour de soi and vicious amour proper, a distinction on which the whole of Rousseau’s moral and political theory rests. -/- 14. Samuel von Pufendorf and the new science of morality. The chapter is dedicated to the discovery of the idea of a ‘new moral science’. Hugo Grotius is discussed first highlighting the real character of his project, much closer to the Thomist idea of a natural law accessible to non-corrupted human reason when human beings are living in a state of pura natura. Then Hobbes’s combination of scepticism, voluntarism, and conventionalism is described and both the continuity with Grotius’s new science, in the search for non-revealed rational morality, and the break with him, in the adoption of voluntarism and refusal of an intellectualist view of natural law, are illustrated. Pufendorf’s work is illustrated as a synthesis of the two previous attempts and the – up to Schneewind underestimated – paradigmatic example of the new science of morality. -/- 15. Richard Cumberland and consequentialist voluntarism. The chapter gives an overview of eighteenth-century Anglican ethics, noticing how the Cambridge tradition gave special weight to natural theology as opposed to positive or revealed theology – and how two Cambridge fellows, John Gay and Thomas Brown, elaborated on Cumberland’s (and Malebranche’s, as well as Leibniz’s) strategy for finding a third way between intellectualist view and voluntarist view of the laws of nature. The result of their elaboration was a kind of a rational-choice account of the origins of natural laws, where a law-giver God chooses among a number possible sets of laws on a maximizing criterion, and God’s maximandum is happiness for his creatures. The chapter notices also how such a solution aimed at solving at once the problem of evil and that of the foundation of moral obligation by proving how God’s choice was justified as far as it was the one minimising the amount of suffering in the world. 16. Richard Price and intuitionism. The chapter describes first the doctrines of the Cambridge Platonists, an example of hyper-rationalist reaction to Calvinism. Secondly it describes the sophisticated and universally ignored – from Sidgwick to Anscombe –version of what was later labelled ‘ethical intuitionism’ – showing how it escapes familiar objections and misrepresentations of intuitionism – from Mill to Rawls – in grounding its argument on transcendental arguments while carefully avoiding recourse to introspection and psychological evidence, which has been taken as a too easy target by critics of intuitionism. Thirdly, the chapter discusses Whewell’s ‘philosophy of morality’, as opposed to ‘systematic morality’, not unlike Kant’s distinction between a pure and an empirical moral philosophy. Whewell worked out a systematization of traditional normative ethics as a first step before its rational justification; he believed that the point in the philosophy of morality is justifying a few rational truths about the structure of morality such as to rule hedonism, eudemonism, and consequentialism; yet a system of positive morality cannot be derived solely from such rational truths but requires consideration of the ongoing dialectics between idea and fact in historically given moralities. Whewell’s intuitionism turns out closer to Kantian ethics than commentators have made us believe until now, and quite different from what Sidgwick meant by intuitionism. -/- 17. Adam Smith and the morality of role-switch. The chapter describes first, Hutcheson’s attempt at basing the ‘new science’ of natural law on different bedrock than Pufendorf and the English Platonists, namely a moral sense, a faculty whose existence is assumed to be proved on an empirical basis. The second step is a reconstruction of Hume’s rejoinder in terms of a new science of man including morality on an ‘experimental’ basis, that is, a ‘Newtonian’ hypothetical-deductive approach, distinguished from Hutcheson’s allegedly uncritical descriptive approach to human nature. The third step is a reconstruction of Adam Smith theory of morality understood as emerging from a spontaneous interplay of exchanges of situations (the most basic meaning of the word ‘sympathy’ as construed by this author). -/- 18. Jeremy Bentham and utilitarianism. The bulk of the chapter is dedicated to the doctrines of Jeremy Bentham. The Enlightenment spirit that suggested the idea of a new morality, free from religion, is illustrated. The notion of utility is illustrated as well as the subsequent formulations of the principle of utility. The idea of felicific calculus is discussed, showing how its inner difficulties prompted several reformulations of the principle of utility in order to avoid undesirable implications of proposed formulations. The role of the thesis of spontaneous convergence between interest and duty is discussed, showing how it left numberless questions open, and the distinction between the virtues of prudence, justice and beneficence is described as a way out of the deadlocks of classical utilitarianism. After Bentham, Mill’s reformed utilitarianism is reconstructed, showing how it is a kind of mixed system – as closer to common sense as it gives up Bentham’s claims to consistency and simplicity – resulting as unintended consequences from the controversies in which Mill was too keen to engage. The hidden agenda of the controversy between Utilitarianism and Intuitionism, going beyond the image of the battle between Prejudice and Reason, is described, showing how both competing philosophical outlooks turn out to be more research programs than self-contained doctrinal bodies, and such programs appear to be implemented, and indeed radically transformed while in progress thanks to their enemies no less than to their supporters. -/- 19. Immanuel Kant, practical reason and judgment. The chapter argues that Kant took from Moses Mendelssohn the idea of a distinction between geometry of morals and a practical ethic. He was drastically misunderstood by his followers precisely on this point. He had learned from the sceptics and the Jansenists the lesson that men are prompted to act by deceptive ends, and he was aware that human actions are also empirical phenomena, where laws like the laws of Nature may be detected. His practical ethics made room for judgment as a holistic procedure for assessing the saliency of relevant moral qualities in one given situation; this procedure yields the same results as the geometry of morals does for abstract cases but does so immediately and without balancing conflicting duties with each other, since what makes for the salient quality of a situation is perceived from the very beginning. Kant's practical philosophy is richer than the received image, making room for an ‘empirical moral philosophy’ or moral anthropology including treatment of commerce, needs, value and price, happiness and well-being; the overall social theory and philosophy of history is less different from Adam Smith's than the received image makes believe; the paradox of happiness is central to Kant's philosophy; a distinction between happiness and well-being is clearly drawn; the distinction plays a basic role in establishing a link between the economic and the moral life. -/- 20. Georg Wilhelm Friedrich Hegel and the critique of abstract universalism. The chapter describes first the Romantic movement and the implications some of its concerns, rescuing passions, community, tradition, the individual as the bearer of a unique destiny, and the longing for organic unity between the individual, mankind and nature. Hegel’s contribution is discussed then, highlighting how, on the one hand, he shared a number of these concerns and on the other he had more rationalist leanings. The notion of morality is the pivotal point of the reconstruction, highlighting how Hegel construes this notion as a key to his own diagnosis of the malaise of modernity – the separation of individual and Gemeinschaft – and how his attack on Kant turns around this very idea. -/- 21. Friedrich Nietzsche against Christianity and the Enlightenment. The chapter illustrates first the idea of deconstruction of the back-world of values. Nietzsche claims to be legitimate heir of the French moralists, Leibniz, Kant and Hegel, in so far as he allegedly carries out to its deepest implications their discovery of what lies behind traditional naïve belief in the existence of an objective realm of values just waiting for description by the philosopher. The two exemplars form which genealogy draws inspiration are the classical philologist’s historical reconstructions of lost meanings and the chemist’s decomposition of elements. Then the genealogy of the notions of good and evil carried out in the first dissertation of Genealogy of morals is illustrated with its paradoxical conclusion that will to power is in fact the only ‘genuine’ kind of goodness. The third point illustrated is the dialectic of ascetism and self-realization with its ambiguous outcome. The suggested interpretation of such outcome is that Nietzsche’s normative ethics is a kind of virtue ethics taking an aesthetic ideal as a normative standard -/- 22. George Edward Moore and ideal utilitarianism. The chapter discusses the ideas of common sense and common-sense morality in Sidgwick. I argue that, far from aiming at overcoming common-sense morality, Sidgwick aimed purposely at grounding a consist code of morality by methods allegedly taken from the natural sciences to reach, also in ethics, the same kind of “mature” knowledge as in the natural sciences. His whole polemics with intuitionism was vitiated by the a priori assumption that the widespread ethos of the educated part of humankind, not the theories of the intuitionist philosophers, was what was worth considering as the expression of intuitionist ethics. In spite of a naïve positivist starting-point, Sidgwick was encouraged by his own approach in exploring the fruitfulness of coherentist methods for normative ethics. Thus, Sidgwick left an ambivalent legacy to twentieth-century ethics: the dogmatic idea of a “new” morality of a consequentialist kind, and the fruitful idea that we can argue rationally in normative ethics albeit without shared foundations. Then it reconstructs the background of ideas, concerns and intentions out of which Moore’s early essays, the preliminary version, and then the final version of Principia Ethica originated. I stress the role of religious concerns, as well as that of the Idealist legacy. I argue that PE is more a patchwork of rather diverging contributions than a unitary work, not to say the paradigm of a new school in Ethics. I add a comparison with Rashdall’s almost contemporary ethical work, suggesting that the latter defends the same general claims in a different way, one that manages to pave decisive objections in a more plausible way. I end by suggesting that the emergence of Analytic Ethics was a more ambiguous phenomenon than the received view would make us believe, and that the wheat (or some other gluten-free grain) of this tradition, that is, what logic can do for philosophy, should be separated from the chaff, that is, the confused and mutually incompatible legacies of Utilitarianism and Idealism. -/- 23. Edmund Husserl and the a-priori of action. The chapter illustrates first the idea of phenomenology and the Husserl’s project of a phenomenological ethic as illustrated in his 1908-1914 lectures. The key idea is dismissing psychology and trying to ground a new science of the a priori of action, within which a more restricted field of inquiry will be the science of right actions. Then the chapter illustrates the criticism of modern moral philosophy carried out in the 1920 lectures, where the main target is naturalism, understood in the Kantian meaning of primacy of common sense. The third point illustrate is Adolph Reinach’s theory of social acts as a key the grounding of norms, a view that basically sketches the very ideas ‘discovered’ later by Clarence I. Lewis, John Searle, Karl-Otto Apel and Jürgen Habermas. A final section is dedicated to Nicolai Hartman, who always refused to define himself a phenomenologist and yet developed a more articulated and detailed theory of ‘values’ – with surprising affinities with George E. Moore - than philosophers such as Max Scheler who claimed to Husserl’s legitimate heirs. -/- 24. Bertrand Russell and non-cognitivism. The chapter reconstructs first the discussion after Moore. The naturalistic-fallacy argument was widely accepted but twisted to prove instead that the intuitive character of the definition of ‘good’, its non-cognitive meaning, in a first phase identified with ‘emotive’ meaning. Alfred Julius Ayer is indicated as a typical proponent of such non-cognitivist meta-ethics. More detailed discussion is dedicated to Bertrand Russell’s ethics, a more nuanced and sophisticated doctrine, arguing that non-cognitivism does not condemn morality to arbitrariness and that the project of a rational normative ethics is still possible, heading finally to the justification of a kind of non-hedonist utilitarianism. Stevenson’s theory, another moderate version of emotivism is discussed at some length, showing how the author comes close to the discovery of the role of a pragmatic dimension of language as a basis for ethical argument. Last of all, the discussion from the Forties about Hume’s law is described, mentioning Karl Popper’s argument and Richard Hare’s early non-cognitivist but non-emotivist doctrine named prescriptivism. -/- 25. Elizabeth Anscombe and the revival of virtue ethics. The chapter discusses the three theses defended by Anscombe in 'Modern Moral Philosophy'. I argue that: a) her answer to the question "why should I be moral?" requires a solution of the problem of theodicy, and ignores any attempts to save the moral point of view without recourse to divine retribution; b) her notion of divine law is an odd one more neo-Augustinian than Biblical or Scholastic; c) her image of Kantian ethics and intuitionism is the impoverished image manufactured by consequentialist opponents for polemical purposes and that she seems strangely accept it; d) the difficulty of identifying the "relevant descriptions" of acts is not an argument in favour of an ethics of virtue and against consequentialism or Kantian ethics, and indeed the role of judgment in the latter is a response to the difficulties raised by the case of judgment concerning future action. A short look at further developments in the neo-naturalist current is given trough a reconstruction of Philippa Foot’s and Peter Geach’s critiques to the naturalist-fallacy argument and Alasdair MacIntyre’s grand reconstruction of the origins and allegedly unavoidable failure of the Enlightenment project of an autonomous ethic. -/- 26. Richard Hare and neo-Utilitarianism. The chapter addresses the issue of the complex process of self-transformation Utilitarianism underwent after Sidgwick’s and Moore’s fatal criticism and the unexpected Phoenix-like process of rebirth of a doctrine definitely refuted. A glimpse at this uproarious process is given through two examples. The first is Roy Harrod Wittgensteinian transformation of Utilitarianism in pure normative ethics depurated from hedonism as well as from whatsoever theory of the good. This results in preference utilitarianism combined with a ‘Kantian’ version of rule utilitarianism. The second is Richard Hare’s two-level preference utilitarianism where act utilitarianism plays the function of eventual rational justification of moral judgments and rule-utilitarianism that of action-guiding practical device. -/- 27. Hans-Georg Gadamer and rehabilitation of practical philosophy. The post-war rediscovery of ethics by many German thinkers and its culmination in the Sixties in the movement named ‘Rehabilitation of practical philosophy’ is described. Among the actors of such rehabilitation there were a few of Heidegger’s most brilliant disciples, and Hans-Georg Gadamer is chosen as a paradigmatic example. His reading of Aristotle’s lesson I reconstructed, starting with Heidegger’s lesson but then subtly subverting its outcome thanks to the recovery of the central role of the notion of phronesis. -/- 28. Karl-Otto Apel and the revival of Kantian ethics. Parallel to the neo-Aristotelian trend, there was in the Rehabilitation of practical philosophy a Kantian current. This started, instead than the rehabilitation of prudence, with the discovery of the pragmatic dimension of language carried out by Charles Peirce and the Oxford linguistic philosophy. On this basis, Karl-Otto Apel singled out as the decisive proponent of the linguistic and Kantian turn in German-speaking ethics, worked out the performative-contradiction argument while claiming that this was able to provide a new rational and universal basis for normative ethics. An examination of his argument is some detail is offered, followed by a more cursory reconstruction of Jürgen Habermas’s elaboration on Apel’s theory. -/- 29. John Rawls and public ethics as applied ethics. Rawls’s distinction between a “political” and a “metaphysical” approach to one central part of ethical theory, namely the theory of justice, is interpreted as a formulation of the same basic idea at the root of both the principles approach and neo-casuistry, both discussed in the following chapter, namely that it is possible to reach an agreement concerning positive moral judgments even though the discussion is still open – and in Rawls’ view never will be close – on the basic criteria for judgment. -/- 30. Beauchamp and Childress and bioethics as applied ethics. The chapter presents the revolution of applied ethics while stressing its methodological novelty, exemplified primarily by Beauchamp and Childress principles approach and then by Jonsen and Toulmin’s new casuistry. -/- . (shrink)

Parents in the US and other societies are increasingly refusing to vaccinate their children, even though popular anti-vaccine myths – e.g. ‘vaccines cause autism’ – have been debunked. This book explains the epistemic and moral failures that lead some parents to refuse to vaccinate their children. First, some parents have good reasons not to defer to the expertise of physicians, and to rely instead upon their own judgments about how to care for their children. Unfortunately, epistemic self-reliance systematically distorts beliefs (...) in areas of inquiry in which expertise is required. Second, vaccine refusers and mainstream medical authorities are often committed to different values surrounding health and safety. For example, while vaccine advocates stress that vaccines have low rates of serious complications, vaccine refusers often resist vaccination because it is ‘unnatural’ and because they view vaccine-preventable diseases as a ‘natural’ part of childhood. Finally, parents who refuse vaccines rightly resist the utilitarian moral arguments – ‘for the greater good’ – that vaccine advocates sometimes make. Unfortunately, vaccine refusers also sometimes embrace a pernicious hyper-individualism that sanctions free-riding on herd immunity and that cultivates indifference to the interpersonal and social harms that unvaccinated persons may cause. (shrink)

This paper addresses the phenomenological experience of precarity and vulnerability in racialized gender-based violence from a structural perspective. Informed by Indigenous social theory and anti-colonial approaches to intergenerational trauma that link settler colonial violence to the modalities of stress-inducing social, institutional, and cultural violences in marginalized women’s lives, I argue that philosophical failures to understand trauma as a functional, organizational tool of settler colonial violence amplify the impact of traumatic experience on specific populations. It is trauma by design. I (...) explore this through the history of the concept of trauma and its connection to tragedy. I give a brief overview of prominent theories of trauma and contrast these with the work of Indigenous feminist scholar Dian Million (2013), who highlights functional complicity of settler colonial institutions in shaping accounts of trauma in the west. I begin the piece with an important illustration of the kinds of lives and experiences that call for a politicized understanding of trauma in anti-colonial feminist theory. I end by offering an expansive notion of structural trauma that is a methodological pivot for conducting trauma-based gender-based violence research in a decolonial context, which calls for an end to narratives of trauma that are severed from the settler colonial project of Native land dispossession and genocide. [Volume 23, no.1]. (shrink)

Ethical oaths for bankers, economists and managers are increasingly seen as successful instruments to ensure more responsible behaviour. In this article, we reflect on the nature of ethical oaths. Based on John Austin's speech act theory and the work of Emmanuel Levinas, we introduce a performative concept of ethical oaths that is characterised by (1) the existential self-performative of the one I want to be, which is (2) demanded by the public context. Because ethical oaths are (3) structurally threatened by (...) the possibility of infelicity or failure, we stress (4) the behavioural aspect of ethical oaths in economics and business. We conclude that a performative concept of ethical oaths can contribute to more ethical behaviour in economics and business, because the performative involves action and behaviour. At the same time, it becomes clear that a radical new perspective on the nature, function and limitation of oaths is needed. (shrink)

This paper examines whether bank capital ratios and default risk are associated with the gender of the bank’s Chief Executive Officer and Chairperson of the board. Given the documented gender-based differences in conservatism and risk tolerance, we postulate that female CEOs and board Chairs should assess risks more conservatively, and thereby hold higher levels of equity capital and reduce the likelihood of bank failure during periods of market stress. Using a large panel of U.S. commercial banks, we document (...) that banks with female CEOs hold more conservative levels of capital after controlling for the bank’s asset risk and other attributes. Furthermore, while neither CEO nor Chair gender is related to bank failure in general, we find strong evidence that smaller banks with female CEOs and board Chairs were less likely to fail during the financial crisis. Overall, our findings are consistent with the view that gender-based behavioral differences may affect corporate decisions. (shrink)

Mental disorders are often thought to be harmful dysfunctions. Jerome Wakefield has argued that such dysfunctions should be understood as failures of naturally selected functions. This suggests, implicitly, that evolutionary biology and other Darwinian disciplines hold important information for anyone working on answering the philosophical question, ‘what is a mental disorder?’. In this article, the author argues that Darwinian theory is not only relevant to the understanding of the disrupted functions, but it also sheds light on the disruption itself, as (...) well as on the harm that attends the disruption. The arguments advanced here are partially based on the view that a core feature of Darwinism is that it stresses the environmental relativity of functions and dysfunctions. These arguments show a very close empirical connection between social judgments and dysfunctions , which is of interest for psychiatric theory. Philosophically, they lead to the conclusion that the concept of mental disorder is identical to the concept of mental dysfunction. Consequently, it is both misleading and redundant to conceptualize mental disorders as ‘harmful dysfunctions’, and not simply as ‘mental dysfunctions’. (shrink)

Liberal political theory is all too familiar with the divide between classical and welfare-state liberals. Classical liberals, as we all know, insist on the importance of small government, negative liberty, and private property. Welfare-state liberals, on the other hand, although they too stress civil rights, tend to be sympathetic to “positive liberty,” are for a much more expansive government, and are often ambivalent about private property. Although I do not go so far as to entirely deny the usefulness of (...) this familiar distinction, I think in many ways it is misleading. In an important sense, most free-market liberals are also “welfare-state” liberals. I say this because the overwhelming number of liberals, of both the pro-market and the pro-government variety, entertain a welfarist conception of political economy. On this dominant welfarist view, the ultimate justification of the politico-economic order is that it promotes human welfare. Traditional “welfare-state liberals” such as Robert E. Goodin manifestly adopt this welfarist conception. But it is certainly not only interventionists such as Goodin who insist that advancing welfare is the overriding goal of normative political economy. J. R. McCulloch, one of the great nineteenth-century laissez-faire political economists, was adamant that “freedom is not, as some appear to think, the end of government: the advancement of public prosperity and happiness is its end.” To be sure, McCulloch would have disagreed with Goodin about the optimal welfare-maximizing economic policy: the welfarist ideal, he and his fellow classical political economists believed, would best be advanced by provision of a legal and institutional framework — most importantly, the laws of property, contract, and the criminal code — that allows individuals to pursue their own interests in the market and, by so doing, promote public welfare. In general, what might be called the “classical-liberal welfare state” claims to advance welfare by providing the framework for individuals to seek wealth for themselves, while welfarists such as Goodin insist that a market order is seriously flawed as a mechanism for advancing human welfare and, in addition, that government has the competency to “correct market failures” in the provision of welfare. (shrink)

The topics of gravitational field energy and energy-momentum conservation in General Relativity theory have been unjustly neglected by philosophers. If the gravitational field in space free of ordinary matter, as represented by the metric g ab itself, can be said to carry genuine energy and momentum, this is a powerful argument for adopting the substantivalist view of spacetime.This paper explores the standard textbook account of gravitational field energy and argues that (a) so-called stress-energy of the gravitational field is well-defined (...) neither locally nor globally; and (b) there is no general principle of energy-momentum conservation to be found in General Relativity. I discuss the nature and justification of the zero-divergence law for ordinary stress-energy, and its possible connection with the failure of General Relativity to realise Mach's principle. (shrink)

The factors preventing registered nurses from failing students in practice are multifaceted and have attracted much debate over recent years. However, writers rarely focus on what is needed to fail an incompetent pre-registration nursing student in their final placement. This hermeneutic study explored the mentor experience of failing a pre-registration nursing student in their final placement. A total of 19 mentors were recruited from 7 different healthcare organisations in both inner city and rural locations in the southeast of England. Participants (...) took part in individual reflective interviews about their experience of failing a pre-registration nursing student in their final placement. These experiences were interpreted through a hermeneutic discovery of meaning. The new horizon of understanding which developed as a result of this research is framed within the context of moral stress, moral integrity and moral residue with the overall synthesis being that these mentors’ stories presented a new horizon of moral courage. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Editors’ NoteJames M. DuBois, Ana S. Iltis, and Heidi A. WalshFrom childhood, David Slakter had undergone tests and invasive procedures to monitor his nephritis. It was not a surprise when in 2015, doctors told him he needed a kidney transplant. The wife of a childhood friend was a close match and gave him one of her kidneys. Before his transplant, aerobic exercise was difficult; a few months after transplant, (...) Slakter could ride his bike, hike, and work out with a personal trainer. He no longer had to weigh food or gauge his potassium consumption, a concern for people with kidney failure. For Slakter, “life post-transplant has been a significant improvement.”Individuals or family members of those who have received an organ transplant from a living or deceased donor share their stories in this issue of Narrative Inquiry in Bioethics. The symposium is titled “Receiving the Gift of Life: Stories from Organ Transplant Recipients.” Organ transplantation can extend an individual’s life by decades. It can also greatly improve an individual’s quality of life, as was Slakter’s experience. At the same time, organ transplantation is expensive and stressful. Recipients can experience complications, including organ rejection, and there are few appealing alternatives.After her heart transplant, author Leilani R. Graham required four open-heart surgeries, ECMO, and an intra-aortic balloon pump. She experienced delirium, necrotizing pneumonia, and severe muscular atrophy that required her to re-learn how to walk. She struggled with weight gain, explosive mood swings, hair loss, and was terrified that her body would reject the new heart. For Graham, “[Transplant] was not the miracle [she] was hoping for.” Graham says she felt unprepared for and inadequately informed about what to expect after her transplant, which left her “battered, beaten, and bruised” with a 12-inch line from neck to navel and “bullet holes” up and down her torso from the chest tubes. When reflecting on her experience post-transplant, Graham says, “It wasn’t the physical trauma that hurt the most. It was that no one seemed surprised [by the aftereffects of transplant].” Seemingly no one, that is except Graham, who calls on transplant providers to “prioritize empathy.”The symposium editors are Jason T. Eberl and Tristan McIntosh. Three commentary articles, written by Macey Leigh Levan, Heather Lannon, and Vidya A. Fleetwood, Roslyn B. Mannon & Krista L. Lentine, offer important insights into the authors’ stories. The editors thank Mid-America Transplant, the UCSF Lung Transplant Program, Donor Connect, William L. Freeman, MD, MPH, MJIL, CIP, Janet Monk, and the individuals who gave anonymous donations to support the publication of this issue, an open-access VOICES edition of the symposium, and accompanying teaching guides.The research article in this issue, “‘A Shell of My Former Self’: Using Figurative Language to Promote Communication about Patient Suffering,” was written by Tyler Tate, Elizabeth Stein, and Robert A. Pearlman. The relief of suffering is a primary goal of medicine. However, the authors note that clinicians often miss or ignore suffering because they focus on the causes rather than the experience of suffering, or the subjective nature of suffering makes it difficult to discuss. The authors believe that “the key to communicating about suffering lies in finding [End Page vii] the right kind of words to describe the experience” and say that figurative language offers a promising approach. In their research, the authors performed qualitative analysis on 52 works of literature and identified 254 excerpts of figurative language with themes of non-physical or psychological suffering. The authors found 13 salient themes: brokenness, diminishment, disorientation, drowning, emptiness, imprisonment, battle, darkness, isolation, invisibility, lifelessness, punishment, and torture. The authors reiterate that developing a shared language of suffering could foster a therapeutic patient-clinician relationship and improve clinicians’ ability to recognize and address a patient’s experience of suffering.María Susana Ciruzzi wrote the first of two case studies included in this issue. “The Sword of King Solomon” addresses a tragic and difficult subject—how to navigate the situation posed by conjoined twins when “any decision will produce damage and suffering.” The case involves two infant male patients born at 37 weeks gestation as omphalo-ischiopagus conjoined twins... (shrink)

The importance for realism of the concept of truthlikeness was first stressed by Popper. Popper himself not only mapped out a program for defining truthlikeness (in terms of falsity content and truth content) but produced the first definitions within this program. These were shown to be inadequate. But the program lingered on, and the most recent attempt to revive it is that of Newton-Smith. His attempt is a failure, not because of some minor defect or technical flaw in his (...) particular account but rather because the program incorporates a fundamental flaw. However, realists need not despair. There already exists an entirely different program not subject to these criticisms. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:About and Beyond Comorbidity:Does the Crisis of the DSM Bring on a Radical Rethinking of Descriptive Psychopathology?Massimiliano Aragona (bio)Keywordscomorbidity, nosography, phenomenology, philosophy of scienceThe problem of psychiatric comorbidity is part of a series of difficulties of the current diagnostic system which at once were considered as a consequence of the way the system itself is organized (Aragona 2006). It was then believed that a Kuhnian reformulation of the contemporary (...) debate on the problems of the psychiatric diagnosis was very useful because it allowed clarification in a comprehensive picture of the many rivulets of conceptual research in that field.In their comments Zachar (2009) and Banzato (2009) seem to agree with my analysis of psychiatric comorbidity (Aragona 2009a) when it stresses that abnormally high frequencies of co-occurrence are to be explained, in important respects, as a consequence of the way mental disorders are operationalized in the Diagnostic and Statistical Manual of Mental Disorders (DSM; also showing the importance of conceptual clarification to deal with this sort of only apparently pure factual problems). On the contrary, they are both unconvinced of the appropriateness and/or fruitfulness of the use of the Kuhnian technical terms and theory in this context.It could be said that the major aim of the paper was to let clinicians understand the effect of conceptual decisions on what would otherwise seem as a simple empirical finding (in this case, high levels of comorbidity), and that this result seems to be achieved in any case, thus minimizing the importance of a disagreement about the philosophical terms as a pure terminological dispute. Nevertheless, in my work the Kuhnian model had a significant role in the clarification of this matter and it also suggests to the reader a range of possible consequences that are not trivial (Zachar, for example, says to be skeptical about the possibility of a crisis and also about the possibility that a new paradigm could eliminate what I call the [End Page 29] comorbidity anomaly). As a consequence, some of the Kuhnian concepts that seemed to be at odds in this context have to be considered in detail to justify my analysis and its consequences. For reasons of space, I avoid a point-by-point reply to all the comments and I concentrate my discussion on three main points. First, I discuss the background of Kuhn's definition of terms such as anomaly and paradigm, as well as my own reasons for using them. In doing so the details of the psychiatric items under study that I wanted to highlight through the use of these philosophical concepts should emerge more clearly. Second, I discuss the problem of having distinguished between artifactual and real comorbidity. Third, I reconsider some of these problems, looking for their implications for future psychopathological research.Anomalies and ParadigmsBanzato (2009) stresses that comorbidity cannot be a truly Kuhnian anomaly because it is an anticipated side effect of the initial setup of the DSM, and not some unexpected discovery that violates the paradigm-induced expectation. This is a basically correct account of the most known version of Kuhnian anomalies; that is, the tale of some evident nature's failure to conform to clear paradigm expectations, which immediately forces researchers to recognize its importance as a possible source of crisis. However, as is the case for many other Kuhnian terms, he discussed anomalies in several scripts and there are other possible versions of its meaning. In particular, Kuhn (1977, XVII) highlighted that only in very rare cases are anomalies completely unexpected and come out of blue to announce an imminent crisis that leads to a large revolution. More frequently, scientific revolutions are much more smaller, like the discovery of oxygen, and in these cases the process is so gradual that historians find it difficult to say exactly when a discovery was made and who did it. Even in these much smaller cases the usual prelude to changes of this sort is the awareness of anomaly, but here anomalies are not extraordinary events; rather, they are "countless discrepancies between theory and experiment [that] during the course of his career, every natural scientist again and again notices and passes by" (Kuhn... (shrink)